Experience of surgical treatment for cervical esophageal carcinoma

Abstract

To summarize the experience of surgical treatment for cervical esophageal carcinoma. Clinical and follow-up data of 82 patients with cervical esophageal carcinoma undergone surgical treatment in Henan Provincial Cancer Hospital from Dec. 1993 to Dec. 2005 were analyzed retrospectively. The difference of the therapeutic regimen and 5-year survival rate of these patients were evaluated. Before 1997, patients mainly underwent surgical therapy solely (27 cases). After 1997, 50 cases received surgical therapy following neoadjuvant radiotherapy (multimodality group), except 5 early-stage cases received surgical therapy solely. Seventy-three patients underwent esophagectomy without thoracotomy, including 21 cases of invert-stripping of the esophagus, and 52 cases of blunt denudation of esophagus. Nine patients underwent transthoracic esophagectomy. Concurrent monolateral or bilateral cervical lymph node dissection accounted for 14 cases and combined organ resection 12 cases. No serious hemorrhage and tracheal or bronchial tearing occurred. No hospital death occurred. Postoperative complications were found in 14 patients, and the incidence of complication was 19.5%. In sole surgery group, upper incised margins of 5 patients were confirmed to be positive. The laryngeal function of 26 patients in sole surgery group was preserved, while 47 patients in multimodality group preserved. Lymph node metastasis occurred in 14 cases, including 13 cases cervical lymph node metastasis (monolateral 9, bilateral 4) and 1 case of upper mediastinal lymph node metastasis. During follow-up, 3 patients were lost. The total 5-year survival rate was 43%. The patients in multimodality group had higher 5-year survival rate as compared to those in sole surgery group. (50.2% vs 33.9%,chi(2 )=7.17,P=0.007). The 5-year survival rates of patients with transthoracic esophagectomy, esophagectomy plus concurrent monolateral or bilateral cervical lymph nodes dissection or combined organ resection were 36.5%, 45.8% and 33.3% respectively. All the 5-year survival rates of these subgroups were lower as compared to multimodality group. For patients with early stage cervical esophageal carcinoma and with proximal end of residual normal esophagus longer than 2 cm, the optimal therapy should be surgery. For most of the patients, surgery combined with neoadjuvant radiotherapy is the ideal therapeutic strategy, which can lower the risk of positive revised margin, improve the possibility of preserving the laryngeal function and result in the improvement of 5-year survival rate. Esophagectomy without thoracotomy should be preferred. Combined organ resection or bilateral lymph node dissection should be chosen carefully because these operating procedures may lead to severe injury and function lose.